Formulary Information and Pharmaceutical Management Procedures
Defines where members and providers can find the payer's drug formularies, explains that formularies are updated periodically, and summarizes pharmaceutical management procedures (e.g., prior authorization, quantity limits, step therapy) that may apply to covered drugs.
No material clinical or coverage changes in this revision.
Provider Actions & Requirements
Prior Authorization Required
Prior authorization may be required for certain drugs. Providers must submit prior authorization requests through Baylor Scott & White Health Plan’s provider pharmacy processes. See the BSWHP provider pharmacy webpage for submission instructions and any available exceptions.
- For PA submission and forms: https://www.bswhealthplan.com/providers/Pages/Pharmacy.aspx
- Contact BSWHP Pharmacy Help Desk: 1.800.728.7947
Step Therapy May Apply
Step therapy requirements may apply to some formulary agents. Providers should check the formulary legend and the plan’s pharmaceutical management procedures to determine whether step therapy must be completed before coverage is approved.
- Review the formulary legend at: https://www.bswhealthplan.com/Pages/Pharmacy.aspx
- Medicare Part D formularies updated monthly; most others updated quarterly.
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